Transcript Community PBF in Rwanda CHD 2013

Community PBF in Rwanda
CHD 2013
STRUCTURE
MOH
MCH UNIT
MCH DESK
NUTRITION
DESK
COMMUNITY
HEALTH
DESK
FP DESK
EHD
MNH
Introduction
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In 2005, MOH has reinforced 3 major stratagies to
improve the health quality services:
 CBHI(Community Based Health Insurance)
 Performance based financing
 Quality assurance
 The Community PBF started in January 2006, in
all districts of Rwanda, with funding throught
the local administration
Selected indicators 2006-2008
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Number of members of CBHI(Community Based
Health Insurance) ,
Mobilisation of assisted delivery,
Mobilisation in using LLIN(Long Lasting
Insecticide Nets)
Treatment of dehydration of children under 5
years,
Hygiene
Report of Community Activities.
Challenges of this model of
Community PBF 2006-2008
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Use of funds for other priorities of the districts
Delay in reporting indicators
Delay in transfering funds by the districts
Lack of motivation to supervise the community
activities
Lack of tools in data collaction
No reports from the districts to MOH
Lack of mechanisms for data verification
New model CPBF : 2009
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Designed in 2009 to change the challenges of the old
model:
 Trought the TWG of CPBF (MOH and parteners
WB, USAID/MSH, HDP etc…)
 In december 2007: first draft of Community PBF
 The new model proposed in different Health
Centers for review and considerations (MOH
department of policies ; Senior Management;
Health Financing Unit ; Technical Working Group
of Community PBF etc)
Making decision
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Results from the evaluation of selected HCs on the impact of
CPBF show that MOH has reached :
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Increasing of utilization of health services – Assisted delivery,
Preventive of Health care of children under 5 years
Increasing health quality – Post natal care and immunization
Results also show that expanding of PBF at the Community
level can reduce the difficult to realize the MCH indicators:
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Nutritional status
Timely prenatal care utilization
Institutional delivery
Timely postnatal care utilization
Modern contraceptive use
INDICATORS REMUNERATED:
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Nutrition Monitoring: % of children monitored for nutritional status
ANC : Women accompanied/referred to Health Center for prenatal care
within first 4 months of pregnancy
Deliveries: Women accompanied/referred to HC for assisted deliveries
Family Planning: new users referred by CHWs for modern family planning
methods
Family Planning: % of regular users using long term methods (IUD,
Norplant, Surgical/NSV contraception)
Number of TB suspects referred to the health center by the CHW’s
Number of TB patients receiving DOTS at home
Number of couples referred to a health center for PMTCT
Number of households referred to a health center for VCT
CHW’s Reports
Signing Contracts of Community
PBF:
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Improves performance
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Payments made when
proof of the agreed
level of performance
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The Sector Steering
Committee signed the
community contracts
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Data entered at district
level
web-based
database
www.pbfrwanda.org.rw/siscom
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Mécanisme contractuel
entre acteurs
Financement
forfaitaire d’un seul
résultat trimestriel:
Rapport des ASC avec
suivi spécifique de 5
indicateurs (Modèle
national)
Community Health Information
System Data Flow Chart
CHWs Motivation
• Trust and respect from community
members, leaders etc…
• Support from Supervisors and
implementation partners help improve
work;
• Regular trainings, meetings supervision
• In-country study tours to learn from peers in
other districts
• Distance learning
• Community performance-based financing
(PBF);
• Membership in cooperatives for income
generation
CHWs’ Cooperatives
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- Community Health Workers’ (CHWs) cooperatives were initiated in late
2007
- The model was introduced through a transformation process from CHWs
non profit making associations
- Previously, they had associations that were no more than a forum to receive
and share funds from MOH, and after each member would do as they wished
with that money
- Up to-date, 449 cooperatives exist country wide
- However, more are being formed as there are new health centers emerging
100% are operational with approximately 42% CHWs cooperatives legally
registered at national level
- Objective is to have all cooperatives with a legal certificate by end of first
quarter 2012 because of the importance of registration
- This shall be possible through close collaboration between MOH, district
authorities and RCA
Achievements
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for CPBF Program
Implementation of Com PBF in all districts
CHW’S are remunerated by quarter(449 CHWs cooperatives)
Sector Steering Committee are trained on reporting and on all tools used in
reporting and counter verification data
New revised CPBF Contracts in KINYARWANDA are signed between the
SSC and HC;SSC and CHW’s Cooperatives
CHW’s cooperatives data reports are validated by Sector Steering
Committees and submitted to the Community PBF
Health centers and SSC are the principal evaluators in data reported by the
CHW’S and data entered by HC
District Steering Committee and DH are the second evaluators before
sending the reports to the Central level
Central level make analysis on the data reported by the CHW’s before the
payment
Achievements
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for CPBF Program
Monthly CPBF Subcommittee meeting
Monthly Extend Team PBF meeting
Community PBF Audit system is done and the report available
Community PBF Counter verification data, audit is done and
the report is available
Results dissemination for Community PBF counter verification
data presented in coordination meeting with the districts
Program Challenges
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Training: CHWs need training in essential service delivery, data
reporting, and income generation;
Robust verification mechanisms to ensure that minimum
package of community health services has been delivered;
The logistics to deliver the minimum package of community
health services;
Data verification mechanisms on reported indicators;
Communication issues: cell phones for reporting and sharing
information regarding the community-based activities;
Issues related to the design and management of community
health workers’ income generating activities (cooperatives)
PRIORITIES
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Reinforce and increase the data reports provided by the
CHW’s
Reinforce counter verification data at all levels
Reinforce the data analysis reports from CHW’s by the
Sector Steering Committee and Districts Steering
Committee
Reinforce keeping all reports from villages to cells and
to be analysed by the Sector Steering Committees
Regular supervision by Central Level in data collection
by Sector Steering Committee and District Steering
Committee
HE Paul KAGAME with all CHWs
Merci